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Title
IS-H: Cost Reimbursement - Direct Patient Billing Purpose
You can use this program to evaluate billing documents on the basis of arange of condition types. The total of the condition values is shown ascost reimbursement information which means that you can use this reportfor cost reimbursement as part of direct patient billing. Prerequisites
Note that the Cost Reimbursement column is only determined if theinvoice has been cleared. In this case, the Open Items columnwill be empty. Partial payments are not taken into account. If aninvoice has not been cleared, the invoice amount appears in the OpenItems column. If the case has been cleared, the total of relevantcondition values is shown in the Cost Reimbursement column.
To enable you to get an overview of possible cost reimbursement amountsif the case has not yet been cleared, the ClcCostRem field isavailable. This field contains the calculated cost reimbursement if thecase has not yet been cleared. This column lets you total theoutstanding cost reimbursement portions.
Furthermore, the Paid field contains the invoice amount if thecase has been cleared.Features Selection
The selection screen contains the required entry field Institution
and the following parameters:
- The system requires that you fill the Evaluation Period fields
and enter the invoice creation date as of which invoices are to be takeninto account. With regard to the evaluation period, also refer to "
Invoices and Cancellation Documents Included" below. The date ofinvoice creation functions as a performance parameter. Invoices prior tothis date are not considered in the selection. Always specify an invoicecreation date far enough in the past so as to include all relevantdocuments. This concerns, in particular, older invoices, whencancellation is carried out at a later point in the evaluation period.
- In the Invoices group box you can enter selection criteria for
the billing types.
- In the Services group box you can restrict the evaluation to
invoice items of certain services. Apart from the service code in thebilling catalog you can also enter the performing organizational unithere. This information is necessary if, for example you only want toevaluate the services of a chief physician.
- If you wish, you can limit the cases to be evaluated in the Cases
group box. Here you can enter the case number, case type and caseselection.
- You must enter the condition types to be evaluated and the
target currency in the Processing group box. The condition typesare used to determine the cost reimbursement portion of each billingdocument. You can enter a target currency of your choice, regardless ofthe local currency and the billing currency, and the system converts alloutput amounts into this currency.
- In the Output group box you can enter a layout for the
SAP List Viewer (ALV). Youcan choose between the "classic" ALV output with item information(standard output) and grid output. Note however, that item informationis not output in the second option. In standard output you can specifythat item information is to be expanded automatically by the system.(Display items option)
Default Values
- The evaluation period is defaulted with the values last
entered (SET/GET parameter) for this parameter.
- The Invoices From field is defaulted with the evaluation start
date minus two years.
- The system determines all billing types relevant for
direct patient billing, and enters them as the default in the selectionparameter.
- The system defaults the target currency to the local
currency.
- The system proposes condition types relevant for direct
patient billing as condition types.
INCLUDE ISH_EXTRACT_REP OBJECT DOKU ID TX.Output
The list is output with the SAP List Viewer (ALV). This offers you arange of options to tailor the list layout to meet your requirements.Besides the standard ALV output with item information, you can alsooutput the list in a modern grid format. This option does not outputitem information.
Note that when extracts are accessed, the current selection form for thestandard ALV output or the grid output is used. This enables the accessto extracts, while always allowing you to determine the desired outputform.
The Change Layout function lets you show additional columns. Youcan display the amounts of the selected condition values used forevaluation. Note however, that the selection is limited to fivecondition types for output. All selected condition types are, however,used for the calculation.
You can also include the total amounts of technical services, physicianservices and general services. These map summations via the relevantcondition types with the respective use.Invoices and Cancellation Documents Included
The system uses the following invoices and cancellation documents toevaluate the current period starting from the Creation Date:
- All invoices and cancellation documents that were created within the
evaluation period
- Outstanding invoices and cancellation documents created before the
evaluation period
- Invoices paid in the current month, even if they were created before the
evaluation period
This ensures that invoices and cancellation documents are not includedtwice. The system does not have to recognize invoices that were alreadyused in a pervious evaluation. This requires however that the evaluationperiods for evaluations do not overlap.
This results in the following configuration of included invoices thatare displayed in the Comment field:
- Outstanding invoices for the current and a previous period (open
invoice).
- Invoices that were completely canceled in the evaluation period (
Full cancellation current period)
- Invoices cleared in the evaluation period (Invoice cleared)
- Cancellation documents are highlighted in red, and the text "
Cancellation of an invoice" is output in the comment field forthem.Example
RP = Receipt of payment Example 1 Evaluation period 1
Case,,Day patient after RP
Billed,,1000
Cost reimbursement,,400
Paid,,1000
Surgery,,0
Process,,Invoice paid
Case,,Day patient after RP
Billed,,-100
Cost reimbursement,,-50
Paid,,-100
Surgery,,0
Process,,Day patient after RP
This case will not be evaluated in any further periods unless there arecancellations. Example 2 Evaluation period 1
Case,,Day patient before RP
Billed,,1500
Cost reimbursement,,0
Paid,,0
Surgery,,1500
Process,,Invoice open
Case,,Day patient before RP
Billed,,-150
Cost reimbursement,,0
Paid,,0
Surgery,,-150
Process,,Day patient before RP Evaluation period 2
Case,,Day patient before RP
Billed,,1500
Cost reimbursement,,0
Paid,,0
Surgery,,1500
Process,,Invoice open
Case,,Day patient before RP
Billed,,-150
Cost reimbursement,,0
Paid,,0
Surgery,,-150
Process,,Day patient before RP Evaluation period 3
Case,,Day patient before RP
Billed,,1500
Cost reimbursement,,200
Paid,,1500
Surgery,,0
Process,,Invoice paid
Case,,Day patient before RP
Billed,,-150
Cost reimbursement,,-20
Paid,,-150
Surgery,,-150
Process,,Day patient before RP Example 3 Evaluation period 1
Case,,Partial payment
Billed,,1500
Cost reimbursement,,0
Paid,,0
Surgery,,1500
Process,,Partial payment 500 not taken into account Evaluation period 2
Case,,Partial payment
Billed,,1500
Cost reimbursement,,300
Paid,,1500
Surgery,,0
Process,,Payment of balance 1000 -> cleared Example 4 Evaluation period 1
Case,,Temporary waiver
Billed,,1500
Cost reimbursement,,0
Paid,,0
Surgery,,0
Process,,Invoice open
Case,,Temporary waiver
Billed,,-1500
Cost reimbursement,,0
Paid,,0
Surgery,,0
Process,,Full cancellation Example 5 Evaluation period 1
Case,,Partial cancel. following month
Billed,,1500
Cost reimbursement,,150
Paid,,1500
Surgery,,0
Process,,Invoice paid Evaluation period 2
Case,,Partial cancel. following month
Billed,,-500
Cost reimbursement,,-50
Paid,,-500
Surgery,,0
Process,,Partial cancel. after RP following month
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